Judge Orders State to Provide Private Duty Nursing Care

Shared with permission from Elizabeth E. Hogue, Esq.

July 14, 2023, a Judge issued an opinion and order, in which he said that the State of Florida must provide services, including private duty nursing care, to medically fragile children who are living in nursing homes or threatened with institutionalization so that they can live at home [United States of America v. State of Florida, Case No. 12-cv-60460-MIDDLEBROOKS/Hunt, (U.S. District Court for the Southern District of Florida, July 14, 2023)]. This court decision is based on violations of the Americans with Disabilities Act (ADA) and Olmstead v. A.C. ex rel. Zimring [527 U.S. 581 (1999)], a decision of the U.S. Supreme Court. This decision is important for home care providers because, as a result, a significant number of additional children may receive private duty nursing care at home. Similar cases are pending in other states.

The children at issue in this case are under twenty-one years old and have disabilities resulting in their need for services on a daily basis. The children frequently qualify for Medicaid and require help with activities of daily living. Necessary services often include the use of technology or equipment for communication, mobility, breathing, eating, and other tasks along with the use and maintenance of feeding tubes, breathing tubes, ventilators, and wheelchairs.

Children who are institutionalized spend months and sometimes years isolated from family and the outside world. In this case, one hundred forty children were living in nursing homes already and approximately one thousand eight hundred children were threatened with institutionalization.

The Court said:

“They don’t need to be there. I am convinced of this after listening to the evidence, hearing from the experts and touring one of these facilities myself. If provided adequate services, most of these children could thrive in their own homes, nurtured by their own families.”

Then the Court said:

“Several Medicaid services were put at issue, but there is little question that the shortfalls in meeting the need for private duty nursing (or “PDN”) was at the heart of this case – the subject was addressed by nearly every witness who took the stand. The lack of access to PDN was by far the most glaring and critical problem facing families with medically complex children. Most families are receiving nowhere near the number of hours they require…By the close of the evidence, I was convinced that the deficit of PDN in Florida is causing systemic institutionalization.”

The Court then acknowledged that the problem of the lack of adequate PDN services is likely based on staffing shortages. However, the Court refused to accept lack of staffing as a reason to not provide the services children need. The Court noted that many private duty staff members are paid $14.00 per hour on average nationally. The Court observed that increasing wages may result in appropriate availability of staff members. Regardless of the cause, however, the Court was clear that the Medicaid Program must meet the needs of children for private duty care at home in order to prevent unnecessary or threatened institutionalization.

Courts in other states are likely to issue decisions similar to this one. This means that private duty agencies must prepare for an influx of clients/patients. In fact, private duty agencies should take the initiative to partner with state Medicaid Programs to meet the needs of an increasing number of children for private duty services at home. 

The Judge quoted Nelson Mandela in the Conclusion of his opinion:

“There can be no keener revelation of a society’s soul than the way in which it treats its children.”

We can only say, “Amen!”

Industry Voices—Let's Treat Loneliness Like Other Public Health Crises

Fierce Healthcare | By Kyu Rhee, Tom Insel, Dan Russell, Dena Bravata, Boaz Gaon
 
A silent and grossly underserved epidemic of loneliness is affecting 60% of all Americans including 75% of young adults and 40% of older adults—influencing and complicating mental health disorders, physical health disorders, adherence to treatment and increasing hospitalizations.
 
The U.S. Surgeon General, in a recently published and widely discussed “Advisory on our Epidemic of Loneliness and Isolation”, has stated that “we must prioritize building social connection the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders.”
 
Numerous experts have called attention to our loneliness epidemic, describing its negative health impact as similar to “smoking 15 cigarettes a day”. It is time for a systematic approach to address the loneliness epidemic that is crippling US healthcare as well as the quality and health of human relationships in America.

A crucial and pressing step toward achieving this goal is universal screening for loneliness. 
What is loneliness?   
 
Social isolation is the objective lack of interaction with others (as happens when people live alone). Loneliness is similar but refers to the subjective feeling of being alone or the gap between one’s expectations of the quantity or quality of relationships and what is actually experienced.
 
In other words, loneliness is a “subjective feeling that the human connections we need in our life exceed the human connections we have." These feelings, as well as comorbid stress, anxiety and depression, have intensified even as the rates of COVID-19 detections have receded.
 
The “Big Resignation” did not start with COVID-19 and has not slowed down since nor has the adoption of social networks and media that over the past two decades have changed how humans connect and engage with each other. 
 
When the Pew Research Center began tracking social media adoption in 2005, just 5% of American adults used at least one of these platforms. By 2011 that share had risen to half of all Americans, and in 2021 72% of Americans reported using some type of social media. Ad-driven social media sites have made it infinitely easier to create new “human” connections — but research has shown that adults with high social media use seem to feel more socially isolated than their counterparts with lower social media use.
 
We are all connected it seems—and yet, we are more disconnected than ever.  

Read Full Article

Sleep Is a Sign of the Dying Process

By Barbara Karnes | August 09, 2023

We tend to forget that life is a terminal illness. We are born, we experience, and then we die. All of living is on the road to death. How is that for a downer?  

The thing is dying is a part of living. Like living, it has stages - a road to travel. The road from birth to death passes through infancy, childhood, adolescence, young adulthood, middle age, old age, and ends at death. This is the normal dying pattern. However, not everyone “plays by the rules” so death can occur anywhere along the life road. Disease can occur anywhere along the life road also.  

Then there is fast death. Fast death is just that: fast, unplanned, no warning, no pattern. Life just ends. No patterns or rules played.

Dying patterns are centered around food, sleep, and socialization. Assess those three areas and you can track the dying process.

In this blog I will focus on sleep. 

Part of the natural dying process from disease is a person begins sleeping more. Starting two to four months before death from disease occurs, a person begins taking an afternoon nap. This progresses to both morning and afternoon naps. Then to both naps plus sleeping in front of the TV in the evening. Before you know it the person is in bed all day, just doesn’t get out of bed, is asleep more than they are awake.  

In a person who is just old with no disease process, the sleep patterns are the same only instead of occurring over a period of months it slowly happens over a period of years. Remember dying can be from just being old. The body is wearing out and is slowly ceasing to function.

As family and caregivers we tend to push our loved one to be active, to get out of bed, to stay awake. Our belief, which is true in most of life, is if we don’t use our body, don’t exercise and stay active, we will become weaker and less able to function. This is not true for someone who has entered the dying process. We have to change our thinking, new rules apply.

Sleep becomes our friend. Our body is like a battery that is losing its charge. Sleep recharges our battery. It doesn’t fix the problem, but for a while it can allow the body to be a little more active. A nap before and after a planned activity may give a bit more energy to enjoy that activity. However, there will come a time in the dying process when the body is simply letting go of the need for being awake. It is letting go if its hold on this planet, of its need for the energy that sleep provides.

The Future of Homecare: Insights from the 2023 HCP Benchmarking Report HHAeXchange

August 15, 2023 (11:00 a.m. MT)

The 14th Annual HCP Benchmarking Report for Home Care, Home Health, and Hospice revealed several opportunities and threats homecare providers are facing today.  Join us on Tuesday, August 15 at 1 PM ET for a discussion with Josh Kondik, VP of Sales at HCP, to unpack the findings and what it all means for you.